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The World Health Organization recognizes World Blood Donor Day on June 14th 2016. This year’s theme is “Blood connects us all,” with the tagline “share life, give blood.” This annual observance focuses on thanking blood donors, while highlighting the connections that are developed worldwide through the gift of giving blood. WHO also aims to encourage regular blood donors to continue giving, and to motivate potential new donors, by sharing the stories of people whose lives have been saved through blood donation [1].

Around 108 million units of donated blood are collected annually around the globe, with approximately half of these collected in high-income countries. However, only 62 countries obtain 100% of their national blood supplies from voluntary unpaid blood donors, with others relying partially on family or paid donors [2]. Thinking about donating? Here are 8 facts about blood donation, in hopes of increasing your knowledge, and encouraging you to donate!

Donated blood can be separated into three different components: red blood cells, plasma, and platelets. These three components can go on to contribute to the recovery of three separate people – explaining how one unit can save three lives [5].

One victim of a motor vehicle collision can require up to 50 units of blood.

That means up to 50 donors contribute to saving the life of someone who has been involved in a car crash! Treatment for leukemia can require up to 8 units of blood per week. Patients undergoing heart surgery can need up to 5 units of blood during the procedure [6].

Your blood type determines who you can donate to, and who you can receive blood from.

People with type O- are universal donors, and people with type AB+ are universal recipients. See the chat below, assembled by Héma-Québec, to learn more about your blood type [7]!

Compatibility of blood types (Source: Hema-Quebec).

The most common blood type in Canada is O+.

About 39% of Canadians have O+ blood, which is why type O blood is most needed in Canada. However, O+ isn’t the most common blood type in every country. For example, A+ is the most common blood type in several countries, including Portugal, Sweden, and Turkey. B+ is the most common blood type in some countries as well, including Pakistan, Bangladesh and India [9].

On average, blood donations take 8-10 minutes.

A full appointment can take up to an hour, due to pre-screening and post-observation. A small amount of your time can make a big difference [8].

200,000 donations are needed by July 1 in Canada.

In order to achieve this goal, 20,000 new donors are needed throughout the months of May and June 2016 [10 ].

Founders of HAAC-SO, from left to right: Akila Whiley, Michelle Patrick, Leah Jones.

The Health Association of African Canadians – Student Organization (HAAC-SO) was formed by Michelle Patrick, Akila Whiley and Leah Jones in the summer of 2015. Patrick is the Promoting Leadership in Health for African Nova Scotians (PLANS) coordinator at Dalhousie, while Whiley and Jones are both students at Dalhousie Medical School. Throughout the 2015-2016 academic year, this group has been involved in raising awareness of African Canadian health issues. We recently interviewed Jones and Whiley to learn more about HAAC-SO.

The Health Association of African Canadians – Student Organization (HAAC-SO) is a sub group of the Health Association of African Canadians (HAAC), which addresses African Canadian health issues and the systemic inequities affecting health. The goal of the student society is to bring students together from Dalhousie University, and beyond, to create a community of learning centered on Black health issues, career development and community engagement.

What events has HAAC-SO been involved with during the 2015-2016 academic year?

Since the start of the school year, HAAC-SO has been involved in a variety of events of awareness events, both at Dalhousie University and in the community. Some of these are listed below:

In your experiences with HAAC-SO, how have partnerships helped you to achieve your goals?

Throughout the year we have made many partnerships; from the Global Health Office, Human Rights Equity and Harassment Prevention Office and many local activists. This has made it possible to host successful events, by event promotion through their networks and financial support. We are thrilled to have had the opportunity to form these valuable partnerships as we are a new organization just getting off the ground!

Over the course of one year, HAAC-SO has managed to make a significant impact on Dalhousie campus. The Global Health Office can’t wait to see what this hard-working group has planned for next year!

On March 30th 2016, the Dalhousie Global Health Office collaborated with the Canadian Red Cross and the Government of Canada to present “Healthcare in Chaos: Best Practices in Global Humanitarian Health Work.” This event consisted of a global health fair, where organizations from the Halifax area shared discussed their global health experiences, a global health themed photo booth, and a panel discussion. The panel was moderated by Pauline Dakin of CBC NS, and featured Dr. Jason Nickerson, Dr. Lynda Redwood-Campbell and Dr. Matthew Hunt.

If you were unable to attend, and are wondering what you missed, have no fear! See our social media round-up below, which includes photographs from the event by David Grandy, and select tweets. More photos can be found on the Global Health Office Facebook page, and event tweets can be found by searching #FacesofHumanity.

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Last week we talked about diagnosing TB, and the importance of determining an appropriate treatment course along with that diagnosis. But how is TB treated, and why is drug resistance an issue with TB in particular?

Although those with latent TB infection do not present symptoms, and cannot spread TB bacteria to others, treatment can still be provided to stop them from developing TB disease. This step is important in eliminating and controlling TB around the world, but should only be initiated once the possibility of TB disease has been excluded. In the United States, four treatment regimens are approved, using combinations of isoniazid, rifampicin and rifapentine. Treatment for latent TB can last anywhere from 3 months to 9 months, necessitating between 12 and 270 doses (minimum) of anti-TB drugs [2].

Treating those with active TB disease is a much more pressing matter, as they have the potential to spread the disease to others. Treatment regimens for active TB disease can last between 6 and 30 months depending on resistance, a process which burdens patients and treatment providers alike [3]. With a treatment course this long, some patients inevitably fail to complete the full regimen, for many reasons including finances, social pressures and inadequate access to proper treatment. To provide a glimpse at the financial burden of TB, each case in Canada cost the healthcare system $47,290 [4]. This can lead to acquired drug resistance, which can then be passed on to others when the infected person, coughs, sneezes or spits, releasing TB bacteria into the air [5].

There are two types of drug-resistant TB: multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). MDR-TB bacteria does not respond to (at least) the two most widely used and powerful first line TB drugs: isoniazid and rifampicin [6]. XDR-TB involves resistance to isoniazid and rifampicin, in addition to resistance to any of the fluoroquinolones (ofloxacin, etc.), and to at least one of three injectable second-line drugs (amikacin, capreomycin or kanamycin) [7]. Both MDR-TB and XDR-TB take longer than regular TB to treat (at least 18 months) and have lower treatment success rates. Furthermore, patients often experience more harsh side effects from treatment, leading to increased hospitalization [8]. In order to maximize the potential for positive treatment outcomes, it is important that further tests are undertaken after initial diagnosis to determine whether bacteria is drug-resistant, and provide appropriate treatment [7].

According to the WHO Global TB Report, in 2014 an estimated 3.3% of new TB cases and 20% of previously treated cases had MDR-TB. More than half of these cases occur in India, China and the Russian Federation. Additionally, an estimated 190,000 people died of MDR-TB in 2014. As of 2015, XDR-TB had been reported in 105 countries. The map below shows the number of patients in these countries with laboratory-confirmed XDR-TB who started treatment in 2014 [9].

Map of the world, showing the number of laboratory-confirmed cases of XDR-TB receiving treatment by country, 2014. (Source: World Health Organization).

In response to treatment non-adherence, and to combat the spread of drug-resistant TB, the directly observed therapy, short-course (DOTS) strategy was developed by WHO in 1994. Health workers meet with patients regularly to help with treatment, adherence, and to provide support and education. This strategy also advocates for increased allocation of domestic and international funding and resources to combat TB [10]. Tuberculosis is also highlighted in two recent worldwide strategies, the WHO End TB Strategy, and the UN Sustainable Development Goals (SDGs), which will be discussed in our next post.

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Now that you have an idea of how TB is spread, its symptoms and its worldwide burden, let’s talk about how TB is diagnosed.

When a patient presents with the symptoms discussed in the last blog post (coughing up blood, cough lasting longer than 3 weeks, unexplained weight loss, etc.), a medical history is taken to determine whether TB infection is probable. Questions that are asked include whether they have been in close contact with someone with TB, if they have a previous history of TB infection, and whether they have an immunocompromising condition (such as HIV) that could increase the risk of latent TB infection progressing to TB disease [2].

There are two primary types of tests that are used to determine if a patient has been infected with TB bacteria: the tuberculin skin test and TB blood tests. The tuberculin skin test (also called the Mantoux tuberculin skin test) involves injecting a small amount of fluid (tuberculin) into the skin of the lower arm. After 48-72 hours have passed, a trained health care worker will look for a raised, hard area or swelling, to determine whether infection is present. TB blood tests (interferon-gamma release assays or IGRAs) measure how a person’s immune system reacts to TB bacteria by testing a blood sample in the laboratory. Blood tests are preferred for those who have had a TB disease vaccine, or who would have difficulty returning for a second appointment. Testing positive on either of these tests does not differentiate between latent TB infection and TB disease, it simply means the person’s body is infected with TB bacteria [3].

Diagnosing active TB involves a series of other tests. Chest X-rays can be used to check for lung abnormalities, but X-rays alone cannot provide a definitive TB disease diagnosis. Sputum Smear Microscopy (SSM) is one of the techniques used to diagnose active TB. Sputum is examined under a microscope for Mycobacterium tuberculosis. SSM can provide results in 24 hours, but it cannot always distinguish between TB and other infections. Polymerase Chain Reaction (PCR) testing can be used to detect genetic material specific to TB in bacteria; however, this test is complicated and can be much more expensive than SSM. Diagnosing TB outside of the lungs can include tests such as a biopsy, lumbar puncture, urine culture or CT scan [4].

Culture techniques, where TB bacteria can be grown in a laboratory from a variety of specimens, are also used to diagnose active TB, though it can take 1-6 weeks to obtain results. Culture techniques are particularly useful in determining an antibiotic treatment course, an important step in combatting TB. One of the largest issues in TB treatment is properly identifying and targeting drug resistance in order to provide appropriate treatment, a topic that will be discussed in our next post [5].

The World Health Organization (WHO) has declared March 24, 2016 as World Tuberculosis (TB) Day [1]. Over the month of March, the Global Health Office will be publishing a series of blog posts about TB in hopes of raising awareness of its worldwide impact. WHO’s “End TB Strategy” has a goal of ending the TB epidemic by 2030, by targeting poverty, improving testing and treatment, ending stigma and discrimination, and driving research and innovation. Put simply, TB is not yet a disease of the past, but if we unite and focus our efforts, we can make TB history.

Tuberculosis (TB), caused by the bacillus Mycobacterium tuberculosis, is an airborne disease that primarily affects the lungs (pulmonary TB) [2]. This means that when people with pulmonary TB cough, sneeze or spit, TB bacteria are propelled into the air, giving them the potential to spread from person to person via inhalation. TB can affect other sites as well, including the brain, the kidneys and the bones [3]. An ancient disease, TB has affected humans for over 4,000 years [2].

In many cases, the immune system will fight off the TB bacteria, and no infection occurs. If the immune system is not able to completely fight off the bacteria, some inactive bacteria may stay in the body, leading to latent TB infection (no symptoms). If the immune system does not respond sufficiently, active TB infection occurs (TB disease), and symptoms begin to manifest [4]. People with latent TB infection cannot spread TB bacteria to others, but can go on to develop active TB over time. WHO estimates that about one-third of the world’s population is infected with latent TB [5]. Symptoms of TB disease include a persistent cough of 3 weeks or longer, pain in the chest, coughing up blood or sputum, weakness or fatigue, weight loss, loss of appetite, chills, fever and night sweats [6].

The burden of TB is mainly concentrated in low and middle income countries, where 95% of TB deaths occur. In 2014, there were 1.5 million TB deaths, and 9.6 million people developed TB disease [5]. TB is one of the leading causes of deaths from infectious diseases worldwide [7]. The map below, produced by WHO, shows estimated TB incidence rates, by country, in 2014.

Map of the world showing estimated TB incidence rates, by country, in 2014 (Source: World Health Organization).

This map provides a visual representation of the worldwide burden of TB, with the lowest rates in Western Europe, Canada, the United States of America, Australia and New Zealand. This has led to a common misperception in higher income countries that TB is a disease of the past. However, in many countries, including Lesotho, South Africa, Swaziland and Mozambique, rates are still above 500 cases per 100,000 population [7].

Keep reading our series of blog posts on TB to learn more about risk factors, diagnosis, treatment and much more.

The most prominent global health issue in the media in 2016 (so far) has, without a doubt, been Zika virus. On February 1, the World Health Organization (WHO) labeled Zika virus a public health emergency of international concern [1]. This has led to increased media coverage, particularly around the potential link between Zika virus and microcephaly. You may be wondering: what is Zika virus, where did it come from, how is it transmitted, and should you be concerned? Fortunately for you, we answer these questions, and many more, in this blog post!

Zika virus was first identified in rhesus monkeys through a sylvatic yellow fever monitoring network in Uganda in 1947. The first cases in humans were discovered in 1952, in Uganda and the United Republic of Tanzania [2]. Zika virus is vector-borne, meaning that an infected living organism transmits the infectious disease between animals and humans, usually through its bite. The Aedes mosquito is the vector in the case of Zika, the same mosquito that spreads chikungunya, malaria and yellow fever [3]. Other forms of transmission include from mother to child, through sexual contact and through blood transfusion [4]. Approximately 1 in 5 people who are infected with Zika through these channels go on to become ill. The most common symptoms are fever, rash, joint pain and conjunctivitis (red eyes). The time from exposure to experiencing symptoms (the incubation period) is not yet known; however, the CDC estimates that it is likely to be a few days to a week [5]. These symptoms are acute, common to many other illnesses, and rarely severe, meaning that many people who have Zika may not realize they have been infected.

Zika virus has been around for more than 60 years, so why are we suddenly so concerned in 2016? There have been outbreaks in the past in Africa, Southeast Asia and the Pacific Islands, but Zika virus gained international attention in the media due to events in Brazil in the second half of 2015. The ministry of health in Brazil first reported that Zika was circulating within the country on May 15 2015. Seven months later on December 24, the country declared a state of emergency due to a dramatic increase in cases of microcephaly (abnormal smallness of the head which can lead to neurological defects) in newborn babies. There were 150 cases recorded in all of 2014 in Brazil, compared to 2700 cases recorded from January to October 2015. Between October 2015 and January 20 2016, there were an additional 3893 cases of suspected microcephaly reported [6]. Brazil has also reported an increased number of cases of Guillain-Barré syndrome (GBS) in the same time period. GBS is a rare illness in which a person’s own immune system damages the nerve cells, causing muscle weakness, and sometimes, paralysis [7]. A total of eight countries/territories (Brazil, French Polynesia, El Salvador, Venezuela, Colombia, Martinique, Honduras and Suriname) have reported a temporal association between the emergence of Zika virus and microcephaly and/or GBS [8]. Although a causal association between Zika and these neurological disorders has not yet been proven, a growing body of both clinical and epidemiological data suggest this is the case. Further studies are currently underway in order to confirm (or refute) the link [9].

Stay tuned for Part II, which will examine risk factors, further implications, prevention and control measures and myths around Zika virus.

Do you know someone who actively contributes to the global health community at Dalhousie? This can come in many forms, including:

– Demonstrated leadership in global health

– Work with marginalized communities

– Engagement in global health research

– Mentorship in global health

– Promotion, development and enhancement of global health at Dalhousie

The Global Health Office would like to give them recognition for their hard work! Each year, the GHO presents three global health awards, one each to a deserving student, resident and faculty member.

The Dr. Ronald Stewart Award for Student Leadership in Global Health is given to a student of Dalhousie Medical School or in the faculties of health professions or dentistry, who has demonstrated leadership in global health and a commitment to improving the health of marginalized communities during their time at Dalhousie.

This award honours Dr. Stewart’s personal, professional and educational support and dedication to global health, and the advancement of social capital worldwide. Dr. Stewart, a former provincial Minister of Health and Order of Canada recipient, has been enriching students’ experiences at Dalhousie Medical School for many years as a popular and accomplished educator, past director of the Medical Humanities program and a key champion for global health education.

The Dr. TJ (Jock) Murray Award for Resident Leadership in Global Health is in recognition of a resident at the Dalhousie Medical School who demonstrates an ongoing commitment and leadership in global health.

Dr. Murray is a former dean of Dalhousie Medical School and professor of medicine (neurology), as well as a founding director of the Dalhousie Multiple Sclerosis Research Unit. He held the first Chair of Medical Humanities at Dalhousie.

Dr. Murray has appointments in the Department of Medicine, the Division of Medical Education and Medical Humanities, and has cross-appointments in the Departments of History, Family Medicine and Community Health and Epidemiology. He was elected a fellow of the Canadian Academy of Health Sciences and he is an Officer of the Order of Canada. He is an advocate for the values within global health.

The Dr. John Savage Memorial Award for Faculty Leadership in Global Health recognizes an outstanding humanitarian contribution to global health by a Dalhousie Medical School faculty member.

Dr. Savage was a former mayor of Dartmouth, premier of Nova Scotia and a family physician. He was also a champion of the need to promote healthy communities worldwide and had a long-standing commitment to global health projects in Africa with the Nova Scotia Gambia Association (NSGA). Dr. Savage also served on the advisory committee to the GHO at Dalhousie University.

To nominate a deserving candidate for any one of these awards, please complete the online nomination form and submit the additional required documents (CV, nomination letter) to the Global Health Office by email at gho@dal.ca. The deadline for nominations is March 1, 2016.

Are you a Dalhousie student in Health Professions, Dentistry or Medicine planning an education experience abroad? The Global Health Office is here to help make your experience as meaningful as possible.

We offer one of the most advanced pre-departure training sessions available to students in Canada. Students must complete two sessions before departure, which are scheduled for Saturdays February 22, March 5 and March 26, 2016, 9:00am-3:30pm. In Halifax, these sessions will be held in Tupper Room G36 and in Saint John, they will be held in DMNB Room 218.

The pre-departure curriculum has been developed to help make the most of your experience, no matter where you plan to do an elective. Topics covered will include safety, logistics, ethics and cultural competency. We have also included a pre-departure checklist on our website, to guide you as you organize your international educational experience.